Dental materials accidentally ingested by patients are often discharged spontaneously, and cases of stagnation in the gastrointestinal tract leading to laparotomy are rare. We report a case of laparotomy due to accidental ingestion of a piece of dental metal. The patient was a 42-year-old woman who was aware of accidental ingestion and had developed lower abdominal pain. She underwent imaging examinations, which showed a structure similar to a piece of dental metal. She consulted a gastrointestinal surgeon who diagnosed it as a gastrointestinal foreign body stagnant in the ileocecal valve. Intraoral findings revealed that the inlay had detached, and its shape was reported. Exacerbation of abdominal symptoms was possible, but we expected that they would be resolved spontaneously on refraining from eating and drinking. However, the foreign body presumably remained stagnated even 14 days after the accidental ingestion. Owing to possible obstruction, perforation, and peritonitis, open laparotomy for foreign body removal was performed 18 days after accidental ingestion. After removal, the pain in the lower abdomen disappeared, and the course was good. Sharp dental instruments can stagnate in the gastrointestinal tract; however, small pieces of metal are often expelled spontaneously. Nevertheless, even a blunt instrument approximately 10mm long may stagnate in the digestive tract leading to serious complications, and so follow-up using imaging tests is necessary to confirm the discharge of foreign substances. If an object is stagnant, immediate consultation to decide on a treatment policy is necessary.
Myoepithelial carcinoma is a rare malignant tumor of the salivary gland with a frequency of less than 2%. We report a case of myoepithelial carcinoma that developed in the palate 4 years after being extirpated as myoepithelioma at the previous hospital. The patient was a 78-year-old female with a 28×18mm swelling on the right soft palate. On enhanced computed tomography imaging, a tumor of 30×20mm in size was found on the right soft palate, and the boundary was unclear. The tumor invaded the right pterygoid process and nasal septum. The histopathological and immunohistochemical diagnosis of biopsy tissue was myoepithelial carcinoma. Positron emission tomography-computed tomography images showed no cervical lymph node metastasis or distant metastasis. An en bloc resection of the tumor and right supra-omohyoid neck dissection under general anesthesia were performed. There has been no sign of recurrence as of 2 years postoperatively. According to the clinical course and histopathological features, this tumor might have initially occurred as myoepithelioma, then myoepithelial carcinoma with aggressive growth potential and invasiveness progressed from the residual myoepithelioma cells after the first extirpation.
Immune thrombocytopenia （ITP） is an acquired autoimmune disease caused by antibody production against platelet-associated antigen. Recently, the onset of ITP after novel coronavirus （SARS-CoV-2） vaccination has been increasingly reported. We report a patient who received antibiotics （SBT/ABPC） after SARS-CoV-2 vaccination, and newly developed ITP through a rapid decrease in the platelet count. The patient was a 25-year-old female after SARS-CoV-2 vaccination. Due to acute purulent periostitis of the mandible, incision of an abscess was performed. Petechia and a rapid decrease in the platelet count （7,000/μl） were observed 2 days after the start of SBT/ABPC administration. Under a tentative diagnosis of drug-induced thrombocytopenia, drug administration was discontinued and platelet transfusion was performed. However, there was no response. Bone marrow biopsy did not show any abnormal findings, leading to a diagnosis of ITP. High-dose intravenous immunoglobulin/steroid combination therapy was started, resulting in prompt recovery of the platelet count. Concerning the etiological factor responsible for the decrease in the platelet count in the present case, it was difficult to differentiate drug （antibiotic）-induced thrombocytopenia from the incidental onset of ITP. Furthermore, the patient had received SARS-CoV-2 vaccination 15 days before the onset of ITP, suggesting a vaccination-related ITP onset. Serious thrombocytopenia may induce complications, such as abnormal hemorrhage, leading to a fatal outcome. Considering the prompt discontinuation of drug administration/switching and the possibility of ITP onset, it may be important to establish a system for close cooperation among medical departments so that prompt, adequate systemic management may be performed.
Marginal mandibulectomy is a highly difficult procedure because the surgeon must consider the three-dimensional invasive pattern of the lesion, residual mandibular morphology, and preservation of anatomical structures. Using a computer-assisted custom-made cutting guide and a custom-made mandibular reconstruction plate （TruMatchⓇ system） is beneficial for marginal mandibulectomy because lesions can be resected using a minimally invasive and accurate surgery. We report here two cases of marginal mandibulectomy using the TruMatch system.
Case 1: The patient was a 70-year-old woman with a recurrent ameloblastoma of the right mandible. The tumor was the multicystic type associated with many cystic-like lesions. The tumor was resected by performing marginal mandibulectomy using the TruMatch system and mandibular reinforcement with a mandibular reconstruction plate.
Case 2: The patient was a 46-year-old woman with recurrent ameloblastoma of the left mandible. The tumor was solid at biopsy. The pathological diagnosis was ameloblastoma （follicular type）, and extended mandibulectomy was indicated. As marginal mandibulectomy just above the inferior alveolar canal was planned, the TruMatch system was used to ensure preservation of the inferior alveolar nerve.
In conclusion, TruMatch, consisting of a computer-assisted custom-made cutting guide and reconstruction plate, was useful for marginal mandibulectomy.